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LifeRing. An Introduction for Addiction Professionals By Martin Nicolaus MA JD CAADAC Region 4 Training Sept. 19, 2009. Objectives. To understand basic facts about LifeRing To get how LifeRing works To pick up tools that can be used with clients

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Lifering

LifeRing

An Introduction for Addiction Professionals

By Martin Nicolaus MA JD

CAADAC Region 4 Training

Sept. 19, 2009


Objectives

Objectives

  • To understand basic facts about LifeRing

  • To get how LifeRing works

  • To pick up tools that can be used with clients

  • To facilitate client involvement with LifeRing


Outline

Outline

  • Hour 1: Basic Facts About LifeRing

  • Hour 2: The Three-S Philosophy

  • Hour 3: How LifeRing Works

  • Hour 4: The Meeting Format

  • Hour 5: How To Build Personal Recovery Programs

  • Conclusion: It’s Time for Choices in Recovery


Hour 1

Hour 1

  • Basic facts about LifeRing

    • What is LifeRing?

    • Where is LifeRing?

    • Who goes to LifeRing?


What is lifering

What is LifeRing?

  • LifeRing is a network of recovery support groups

  • LifeRing is not a treatment program or a treatment protocol

  • LifeRing is compatible with any abstinence-based treatment approach


Where are lifering meetings

Where are LifeRing meetings?

  • There are more than 50 LifeRing meetings in Northern California

  • More than 12 in Canada

  • 2 each in Ireland and Sweden

  • Growing


Where are lifering meetings 2

Where are LifeRing meetings (2)

  • Locally, LifeRing meetings are at:

  • Kaiser CDRPs (Oakland, Union City, Vallejo …)

  • Herrick Hospital

  • Merritt Peralta Institute

  • Mills Peninsula Hospital

  • Center for Recovery (Concord)

  • Mandana Community Recovery Center


Where are lifering meetings 3

Where are LifeRing meetings (3)

  • Mary Isaak Center (Petaluma)

  • Bayside Marin (San Rafael)

  • Sierra Council (Roseville)

  • Strategies for Change (Sacramento)

  • The Effort (Sacramento)

  • Veterans’ Administration Clinic (Ft. Miley)


Where are lifering meetings 4

Where are LifeRing meetings? (4)

  • LGBT Center (SF), Pacific Center (Berkeley)

  • Alano Club (San Francisco)

  • Sutter Medical Center (Santa Rosa)

  • Home of Truth Spiritual Center (Alameda)

  • St. Paul’s Episcopal Church (Benicia)

  • First Presbyterian Church (Livermore)

  • St. Joan of Arc Catholic Church (San Ramon)

  • Unitarian-Universalist Church (Walnut Creek)


Where are lifering meetings 5

Where are LifeRing Meetings (5)

  • Greenwich Hospital (CT)

  • St. Patrick’s Hospital (Dublin, Ireland)


Also meetings online

Also: Meetings Online

  • http://lifering.org(a/k/a http://unhooked.com)

  • Chat room

  • Email lists

  • Forum

  • Social network


Lifering comes recommended

LifeRing comes recommended

“LifeRing has been extremely popular with our clients, and we offer it every Wednesday evening. MPI would recommend LifeRing with enthusiasm and full support to any other drug treatment program.”


Lifering comes recommended 2

LifeRing comes recommended (2)

“Our treatment team believes that there are many viable paths to recovery, LifeRing being one very positive adjunct to our traditional offerings. The LifeRing meeting is a bright spot in the patients’ week, and staff find that participation in the meeting enhances patients’ motivation to get well.”


Lifering comes recommended 3

LifeRing comes recommended (3)

“I am happy to state that LifeRing has always been able to coexist harmoniously with other support meetings. Patients report being satisfied with the format and some say they attend LifeRing and 12-step support meetings. I am happy to recommend LifeRing to any drug treatment program.”


Who goes to lifering

Who goes to LifeRing?

  • According to 2005 membership survey (n = 401):

  • 37 % were referred to LifeRing by a counselor

  • 34% found it on the Internet


Who goes to lifering 2

Who goes to LifeRing (2)

“What parts of your LifeRing experience gives you the greatest satisfaction?”

56%: Absence of religious content

56%: The atmosphere is positive, empowering

53%: Building personal recovery programs

52%: Crosstalk is encouraged


Who goes to lifering 3

Who goes to LifeRing (3)

“Will you recommend LifeRing to your friends?”

Yes: 98 %


Who goes to lifering 4

Who goes to LifeRing (4)

“Have you participated in other recovery groups?”

83% participated in 12-step groups in the past

14 % participated in no other groups before

Currently:

45 % do LifeRing only

36% do both LifeRing and 12-step groups


Who goes to lifering 5

Who goes to LifeRing (5)

Average length of sobriety: 2.74 years

Average age: 47.8

Gender: 58 % male, 42% female

High school graduates: 97%

College degrees: 24%

Professional-technical: 40%

Blue-collar: 15%


Who goes to lifering 6

Who goes to LifeRing (6)

Raised in religion as a child:

38% Protestant

25% Catholic

4% Jewish

8% Other religion

24% Not raised in a religion


Who goes to lifering 7

Who goes to LifeRing (7)

In the past year, attended church (or other house of worship) at least once: 41 %

Every week: 10%

About once a month: 9%

Did not attend during past year: 59%

(National averages:

Every week= ~20 %

Not during past year = ~ 40%)

Source: http://en.wikipedia.org/wiki/Religion_in_the_United_States#Church_attendance


Who goes to lifering 8

Who goes to LifeRing (8)

In the past year, received some type of professional counseling for substance use issues: 47%

In past year, received diagnosis for co-occurring disorder: 45 %

33 % Depression

17 % Anxiety

Details at http://lifering.org/survey/2005_lifering_participant_survey.htm


Who goes to lifering summary

Who Goes to LifeRing: Summary

  • A fairly average cross section of recovery

  • Above average educational levels

  • Below-average religious involvement

  • High level of involvement in treatment


How is lifering organized

How is LifeRing Organized?

  • LifeRing is a 501(c)(3) nonprofit corporation

    • Annual Congress of meeting delegates

    • 9-member Board of Directors

    • All officers and directors are volunteers

    • Bylaws


History of lifering

History of LifeRing

  • Founded locally May 23 1999 in Albany CA

  • Founded nationally Feb 17 2001 in Brooksville FL


Hour two

Hour Two

Basic facts about LifeRing (continued):

The Three-S Philosophy


The three s philosophy 1

The Three-S Philosophy (1)

  • Sobriety

  • Secularity

  • Self-Help


1 sobriety

1Sobriety

= Abstinence

  • Persons with the aim of moderating or controlling are referred elsewhere

  • Persons who have relapsed are welcomed and praised for coming back

    The key is intent


Sobriety cont d

Sobriety (cont’d)

  • Grounds:

    • Personal experience that moderation or control do not work for us

    • Commitment to living with all senses clear

    • Urge to realize our best potentials

      + Drugs suck


Sobriety cont d1

Sobriety (cont’d)

  • Abstinence not only from alcohol but also from all other medically non-indicated drugs

    • For example, a person abstaining from alcohol but using marijuana is not “sober” by LifeRing standards

  • Background:

    • Modern trend: Poly-addiction  Poly-abstinence

    • Segregation by “drug of choice” obsolete

    • All together in the same room (“one-shop stopping”)

    • Same as integrated treatment model


  • Sobriety cont d2

    Sobriety (cont’d)

    Nicotine:

    Not required but strongly encouraged to quit

    All meetings are non-smoking

    Support on quit anniversaries

    Education on web site (lifering.org)


    Sobriety cont d3

    Sobriety (cont’d)

    Nicotine (Background):

    • Nicotine kills more alcoholics than alcohol does

    • Negative example of AA founders

    • More successful outcomes if you quit both

    • Long-term goal: smoke-free LifeRing


    Sobriety cont d4

    Sobriety (cont’d)

    Medications

    (Typically: anti-depressants, anxiety meds)

    • Supported on two conditions:

      • Patient honest with physician

      • Physician competent in addictions

      • Medications = sobriety tools

      • LifeRing convenors are not physicians!


    Sobriety cont d5

    Sobriety (cont’d)

    • Medications (background)

      • Too many persons harmed by refusing medications

      • Too many physicians’ treatments undermined

      • Medications hold potential as recovery aids

        • (Ref: disease model)


    Sobriety cont d6

    Sobriety (cont’d)

    Methadone

    • Exhaustively tested as effective v. heroin

    • If used as prescribed, should be sobriety tool

    • But wide gap between ideal and reality

      Medical marijuana

    • Widespread abuse, “medical” scams

    • If used legitimately (e.g. cancer), should be OK

    • Not much experience to date


    Secularity

    Secularity

    • Secularity = Inclusiveness in matters of belief or disbelief


    Secularity cont d

    Secularity (cont’d)

    Secular

    Ecumenical

    Protestant -- Catholic – Jew -- Muslim

    Unaffiliated


    Secularity cont d1

    Secularity (cont’d)

    • NB ~ 40% of LifeRing participants say they attend church

      • But they prefer to perform their religious observances in church, not in recovery rooms

    • In the LifeRing meeting room, your belief or disbelief remains your private business.


    Secularity cont d2

    Secularity (cont’d)

    • LifeRing not a religious organization

      • No prayers in meetings

      • Non-religious change agent (TBD)

    • Ref: Court decisions re First Amendment

      • Inouye v. Kemna, 504 F.3d 705 (9th Cir. 2007)

      • Parole officer should have known that coerced referral to 12-step groups violates Establishment Clause.

      • Coerced referral to 12-step liable for $$ damages

        • More: Brochure, Counselor article, CAADAC talk


    Secularity cont d3

    Secularity (cont’d)

    • LifeRing not an atheist-agnostic organization

      • No atheist/agnostic advocacy in meetings

      • No attacks on religion in meetings

    • Peaceful Coexistence of all faiths and none

      • No attempt to modify client’s belief system

        • (e.g. God who observes v. God who controls)

      • Many believers prefer secular environment

      • Compare: family reunion


    Secularity cont d4

    Secularity (cont’d)

    • Secularity lets people relax and be real

      • Absence of implied moral judgments

      • Be what you are

      • Safety and freedom in the atmosphere


    Secularity cont d5

    Secularity (cont’d)

    • Secularity is science-friendly

      • E.g. animal research showing that addiction is the product of ingesting addictive substances; not of character attributes or moral qualities

      • E.g. human research showing that every personality type is equally liable to become addicted

      • E.g. research with pharmacological recovery tools


    Secularity cont d6

    Secularity (cont’d)

    • Secular spirituality

      • (Not: supernatural spirituality)

    • LifeRing meetings are strong on

      • Empathy

      • Concern

      • Caring

      • Love

      • Respect

      • Other positive feelings

      •  TBD


    Secularity cont d7

    Secularity (cont’d)

    • Participants who want to explore theological issues:

      • Refer to churches, synagogues, etc.

      • Refer to other qualified professionals

      • Our limits as LifeRing members:

        • Considerable experience with addiction & recovery

        • Not qualified to teach theology


    3 self help

    (3) Self-Help

    • Personal responsibility for one’s own recovery

      • Cannot be delegated away (to God, physician, etc.)

      • Implies a capability to take the responsibility

      • Implies a duty to work and fight

      • Can be a shocking premise for recovering people


    Self help cont d

    Self-Help (cont’d)

    Moment of Existential Panic: Two Outcomes

    • Energized

    • Stimulated

    • Takes Charge

    • Gets to Work

    • Paralyzed

    • Defeated

    • Passive

    • Waits for recovery to happen

    Important for treatment providers to offer choices so that both can prevail


    Self help cont d1

    Self-Help (cont’d)

    • Personal Recovery Programs (PRP)

      • Universal element: Abstinence

      • All other elements: Individualized


    Personal recovery programs

    Personal Recovery Programs

    • Abstinence

    Abstinence


    Self help cont d2

    Self-Help (cont’d)

    • Rationale for Personal Recovery Programs:

      • "1.  No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society."-- National Institute on Drug Abuse (NIDA),  Principles of Drug Abuse Treatment -- A Research-Based Guide  (1999)


    Self help cont d3

    Self-Help (cont’d)

    • "The roads to recovery are many."-- AA Cofounder Bill W., The AA Grapevine, Sept. 1944, Vol. 1 No. 4.


    Self help cont d4

    Self-Help (cont’d)

    • “Treatment should be individualized to accommodate the specific needs, personal goals, and cultural perspectives of unique individuals in different stages of change.” -- Center for Mental Health Services and Center for Substance Abuse Treatment, Substance Abuse and Mental Health Service Administration (SAMHSA), 2006


    Self help cont d5

    Self-Help (cont’d)

    • “There does not seem to be any one treatment approach adequate to the task of treating all individuals with alcohol problems. We believe that the best hope lies in assembling a menu of effective alternatives, and then seeking a system for finding the right combination of elements for each individual.” -- Hester & Miller, Handbook of Alcoholism Treatment Approaches, Effective Alternatives, 1996, p. 33


    Self help cont d6

    Self-Help (cont’d)

    • “With our two centuries of accumulated knowledge and the best available treatments, there still exists no cure for addiction, and only a minority of addicted clients achieve sustained recovery following our intervention in their lives. There is no universally successful cure for addiction – no treatment specific.” – William L. White, Slaying the Dragon, p. 342


    Self help cont d7

    Self-Help (cont’d)

    • “Each patient or client develops problems in unique ways and forms a unique relation to the substance of choice. Common sense dictates that treatment must respond to the needs of each individual.” -- Joyce Lowinson, editor, Substance Abuse: A Comprehensive Textbook, 1996, p. xi.


    Self help cont d8

    Self-Help (cont’d)

    What goes for treatment goes for self-treatment

    • Formula treatment plan + Personal Recovery Program =

    • Individualized treatment plan + Formula recovery program =

    • Individualized treatment plan + Personal Recovery Program =


    Self help cont d9

    Self-Help (cont’d)

    • The clinician’s plan and the patient’s plan

      The most successful client in resisting relapse is one who “confidently acts as his or her own therapist.” – Dimeff & Marlatt, Relapse Prevention, 1995

      “Every patient carries his or her own doctor inside.” -- Albert Schweitzer.


    Self help cont d10

    Self-Help (cont’d)

    • When given a chance, people who were asked and involved in creating their treatment would regularly prescribe for themselves treatment that would work.  Sometimes my only contribution to their success was believing in them until they believed in themselves.“ -- Lori H. Ashcraft and William A. Anthony, “Breaking Down Barriers,” Behavioral Healthcare (April 2008) p. 8


    Self help cont d11

    Self-Help (cont’d)

    • “The first principle of recovery is the empowerment of the survivor. She must be the author and arbiter of her own recovery. … No intervention that takes power away from the survivor can possibly foster her recovery, no matter how much it appears to be in her immediate best interests.” -- Judith Lewis Herman, Trauma and Recovery: The Aftermath of Violence (Basic Books, 1997) p. 133.


    Self help cont d12

    Self-Help (cont’d)

    • “Alcoholics recover not because we treat them but because they heal themselves.” -- George Vaillant MD, Natural History of Alcoholism Revisited, 1996

    • The dominant role in determining treatment success or failure is the role of the patient. (Study cited by Vaillant)


    Self help cont d13

    Self-Help (cont’d)

    What LifeRing does is to

    • take seriously the role of the patient in healing themselves,

    • raise this project into consciousness,

    • legitimize it,

    • and provide support and tools for its accomplishment.


    Self help cont d14

    Self-Help (cont’d)

    • HOW does the recovering person build their PRP?

      • Deferred to Hours 4 and 5

    • Other dimensions of Self-Help

      • Deferred to Hour 6


    The three s philosophy summary

    The Three-S Philosophy Summary

    Sobriety

    Self-Help

    Secularity


    Hour three

    Hour Three

    How LifeRing Works


    How it works outline

    How it works: Outline

    • Empower Your Sober Self: What it Means

    • In more depth:

      • The Divided Self

      • Horizontal Synergy

      • Confrontation v. Support Strategies


    How it works

    How it works

    The main LifeRing motto is

    What does that mean?

    How does it work?

    Empower your Sober Self


    Lifering

    A

    Dominant inside the active alcoholic/addict’s head is the Addiction (A).

    Some people call it the Disease, the Beast, or the Devil. By whatever name, it controls the active alcoholic/addict’s behavior most of the time.

    Metaphor only – not brain anatomy


    Lifering

    But also present in the active addict’s head, at the time when they are ready to commence recovery, is another force: a part of the personality that wants to be clean and sober (S).

    A

    S

    This is the “sober self.”


    Lifering

    Let’s have another, let’s get wasted, damn the consequences …

    A

    No, it’s stupid, we can’t afford it, it’s boring, I have to work tomorrow…

    S

    The inner conflict between these two camps in the mind is a common and unhappy experience of alcoholics/addicts.


    Lifering

    A

    S

    A

    S

    When two or more addicts/alcoholics come together, their interaction can produce two kinds of changes:


    Lifering

    A

    A

    S

    S

    If they meet in a drinking/drugging setting, and if the “Addict” parts of the two brains make mutual contact …


    Lifering

    A

    A

    S

    S

    … they will reinforce one another’s addiction …


    Lifering

    A

    A

    S

    S

    … at the expense of the sober place in the brain …


    Lifering

    A

    A

    S

    S

    … ultimately leading to …


    Lifering

    A

    S

    … overdose, irreparable body damage ...


    Lifering

    A

    … and death.


    Lifering

    A

    S

    A

    S

    But if these same individuals come together in a recovery environment, and …


    Lifering

    A

    A

    S

    S

    … if the sober place in one connects with the sober place in the other …


    Lifering

    A

    A

    S

    S

    … and the other connects back, completing the circuit …


    Lifering

    A

    A

    S

    S

    … then the “S” in both of them will grow and become stronger …


    Lifering

    A

    A

    S

    S

    … and stronger …


    Lifering

    A

    A

    S

    S

    … until the sober self rises …


    Lifering

    S

    S

    A

    A

    … and becomes dominant within the person …


    Lifering

    S

    S

    A

    A

    … so that sobriety stops being an uphill fight …


    Lifering

    S

    A

    … and becomes comfortable and almost effortless.


    Lifering

    S

    A

    The “A” never vanishes entirely. Putting “fuel” into the body would make it come roaring back. In every other way, the person can lead a normal, happy, productive life.


    Lifering

    A

    S

    S

    A

    Positive reinforcement is the “magic” that makes this transformation possible.


    Lifering

    S

    S

    This is the basic meaning of the LifeRing motto:

    “Empower your sober self.”


    How it works background

    How it Works -- Background

    • (1) The Divided Self

      A person who is addicted

      is a person who has

      an inner conflict

    A

    S


    The divided self

    The Divided Self


    The divided self1

    The Divided Self


    The divided self2

    The Divided Self


    The divided self3

    The Divided Self


    The divided self4

    The Divided Self

    Not just a literary metaphor but a clinical reality

    “Addicts simultaneously want – more than anything – both to maintain an uninterrupted relationship with their drug of choice and to break free of the drug. Behaviorally, this paradox is evidenced both in the incredible lengths to which the addict will go to sustain a relationship with the drug and in his or her repeated efforts to exert control over the drug and sever his or her relationship with it.” – Wm. L. White


    The divided self5

    The Divided Self

    “[T]he fierce power of an addict’s obsession with drugs is matched, when the timing is right, by an equally vigorous drive to be free of them.” – Lonny Shavelson MD


    The divided self6

    The Divided Self

    “The majority of substance abusers […] are intensely ambivalent, which means that there is another psychological pole, separate from and opposite to denial, that is in delicate, frequently changing balance with denial and that is a pole of healthy striving.” -- Dr. Edward C. Senay, University of Chicago


    The divided self7

    The Divided Self

    “Alcohol abuse must always create dissonance in the mind of the abuser; alcohol is both ambrosia and poison.” – George Vaillant, MD, Harvard Medical School


    The divided self8

    The Divided Self

    Addictive substances set off an “opponent process” in the brain’s neurochemistry, part pleasurable and part anti-pleasurable – George Koob MD, Scripps Institute San Diego


    The divided self9

    The Divided Self

    DSM-IV Criteria for substance dependence include:

    “a persistent desire or unsuccessful effort to cut down or control substance use” or

    “knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.”

    (In other words: inner conflict)


    The divided self10

    The Divided Self

    • In short:

      The Basic Model

      of Addiction

      Psychology

    A

    S


    The divided self11

    The Divided Self

    The divided self appears to be a bad thing:

    “Paradox” – “fierce power v. vigorous drive” – “intense ambivalence, frequently changing” -- “dissonance in the mind” – “opponent process” – “knowledge of having a problem”

    The inner conflict may feel like torture


    In division lies hope for change

    In division lies hope for change

    But without the Divided Self, recovery would not be possible

    If we see the person as all “S”, there is no reason to change:

    If we see the person as all “A”, there is no way to change:

    S

    A

    There are no living addicted persons who match either of these two diagrams


    Division is the basis of change

    Division is the basis of change

    • A reason to change

    • A basis for change

    A

    S

    “The doctor within” – Albert Schweitzer


    Another view disease model

    Another view: Disease Model

    • Disease

    • Immune System

    A

    S

    “Treatment rests entirely on recognition of the factors contributing to the resistance of the patient.” -- Vaillant


    Two therapeutic strategies

    Two therapeutic strategies

    Attack the A

    Confrontation

    Attack therapy

    “Tough love”

    Synanon

    Many TCs

    Steps 1 - 8

    Support the S

    Strength-based

    MI

    CBT

    REBT

    DBT

    SFT

    (Fellowship)

    (LifeRing)

    A

    S


    Confrontation doesn t work

    Confrontation Doesn’t Work

    • “Four decades of research have failed to yield a single clinical trial showing efficacy of confrontational counseling, whereas a number have documented harmful effects, particularly for more vulnerable populations. … Clinical studies show that more effective substance abuse counselors are those who practice with an empathic, supportive style.” William R. Miller and William White, “Confrontation in Addiction Treatment,” Counselor (October 4, 2007),


    Examples of support strategy

    Examples of support strategy

    • From Lonny Shavelson’s book, Hooked: Five Addicts Challenge Our Misguided Drug Rehab System


    Examples of support therapy

    Examples of support therapy

    • Example 1: Darlene


    Example of support strategy 1

    Example of support strategy (1)

    • Darlene: “If an addict doesn't want to get off drugs, you can just talk at them until your eyes turn blue, and they'll just tell you to fuck off."

    • Dr. S: "Just possibly, that person who you're speaking about may have the teeniest of desires to deal with her drug problem.”

    • Darlene: "Well, what if that person only has the teeniest, teeeniest, tiniest wanting to be off drugs?“

    • Dr. S., shakes Darlene’s hand: "Then I would think that such a person would do very well in this clinic."

      (Shavelson 2001:281)


    Example of support strategy 11

    Example of support strategy (1)

    • Client has “teeniest, tinyest desire to be off drugs”

    • Counselor shakes

      hands, forms therapeutic alliance with client’s “S”

    A

    S


    Example of support strategy 2

    Example of support strategy (2)

    'Evelyn tells me, “Glenda, you're a strong, wise lady.” She says all kinds of things about me that make me feel really good.' -- (Shavelson 2001:204)

    Glenda Counselor Evelyn


    Example of support strategy 21

    Example of support strategy (2)

    • Evelyn

    A

    S


    Example of support 3

    Example of support (3)

    • Drug court counselor Marillac

    • Runs a group with Drug Court clients, mandated to be there

    • Instead of talking tough to clients, spends time bringing out clients’ good points

    • Shavelson asks: Why do you do that? Shouldn’t you be reading them the riot act?


    Example of support 31

    Example of support (3)

    • Marillac “It's just the opposite. I have to be more relaxed with them here. The fact that they're mandated to be in rehab doesn't make their treatment easier, it makes it harder. They have to show up, but then I have to win them over to wanting to change their lives. If I act tough, all I get is an addict who's pissed at another authority figure. So I've got to grab at what good they have inside of them, and they have to see me grabbing it, bringing it out – accepting them.” -- (Shavelson 2001:232)


    Example of support 32

    Example of support (3)

    • Marillac

    A

    S


    Summary

    Summary

    • Different aspects of empowering the sober self:

      • Recognizing

      • Validating

      • Pouring love into

      • Building alliance with

      • Holding up to light

      • Honoring

      • Responding to

      • Relating to


    Hour 4

    Hour 4

    The LifeRing Meeting


    The engine

    The Engine

    A

    A

    S

    S


    Circle seating

    Circle seating


    Large circle

    Large circle


    Short opening statement

    Short Opening Statement

    • Basic meeting philosophy (Sobriety, Secularity, Self-Help)

    • Confidentiality

    • Format

    • Welcome

    • Takes less than 2 minutes


    How was your week

    “How was your week?”

    • Highlights and heartaches of recovery this week

    • Plans and expectations for coming week

    My week went like this … I did … I felt … I thought … and then …

    Next week I face … my plan is …

    S


    How was my week

    How was my week?

    • How was my week? My boss made me go to the office party, even though there was alcoholic punch and I was just a week sober, and I did it and I didn't drink. I feel great.

    • I got together with my sober buddy and we watched the Raiders game and didn't drink, for the first tim e I can remember.

    • I drove home and there were my parents in the living room smoking crack. I ran out of the house and got back in my truck and peeled out of there.

    • My sister and I talked and hugged each other for the first time since my daughter killed her daughter in a car accident when she was drunk, following in my footsteps. Now that I'm sober, we're talking again.

    • I have no money now, nothing at all, and I went to my mom and asked her if I could move back home, and we cried.

    • The week has been a roller coaster of feelings. Sometimes I felt ecstatic, other times I thought I was going insane. But I’m sober.

    • Today is my birthday, and if I make it to bed sober it'll be my first sober birthday since middle school. It’s scary and exciting.


    All lifering meetings encourage cross talk

    All* LifeRing Meetings Encourage Cross-talk

    S

    I had something very similar happen … did you mean? … I think what you did is cool …

    S

    *Except meetings in special settings with highly vulnerable populations


    Cross talk is powerful

    Cross-talk is powerful

    S

    S

    What happens if you only hook up one wire in the jumper cable?


    Cross talk is powerful1

    Cross-talk is powerful

    S

    Horizontal synergy

    S

    S

    S


    Crosstalk is feedback

    Crosstalk is feedback

    • “One general finding in the motivation literature is the persuasiveness of personal, individual feedback. Lectures and films about the detrimental effects of alcohol on people in general seem to have little or no beneficial impact on drinking behavior, either in treatment or in prevention settings.” -- (Hester & Miller 2003:138)


    Some limits on meeting talk

    Some limits on Meeting Talk

    • No attacks or confrontations

    • No unsolicited advice

    • No bashing other recovery programs

    • No religion, pro or con

    • No politics

    • No uncivil behavior

      These are general rules of friendly conversation

      Crosstalk is just another word for conversation


    Aim living room atmosphere

    Aim: Living Room atmosphere

    • Friendly, safe, candid


    How was your week format

    “How was your week?” Format

    YES

    • Here and now focus

    • Personal experience

    • Small decisions

    NO

    • Drunkalogues and Drugalogues

    • Book recitals

    • Infomercials about how the program saved them


    Pluses of the hwyw format

    Pluses of the HWYW Format

    • Low entry barrier -- most people speak on Day 1

    • Speaking leads to self-knowledge

    • One’s own sobriety meaningful to others

    • Ever-changing panorama of issues

    • Democratic, equal-opportunity format

    • Brings sober scrutiny to life decisions

    • Encourages sober planning

    • Helps people carry the meeting with them

    • Atmosphere is positive, encouraging, motivating


    Negatives of the hwyw format

    Negatives of the HWYW Format

    • Limits size of meeting

      Meetings may split into two

      NB Some LifeRing meetings modify the format or use a topic format


    Closing ritual

    Closing ritual

    Round of applause for one another, because:

    • The outside world little understands or appreciates our recovery journey. They tend to believe that we can 'just say no‘ and be done with it. But we who fight this battle every day know the inner struggles we go through and the work that's involved in rebuilding our lives. We appreciate the courage that it takes to be here. Recovery is an estimable project, and we have earned the sober self-esteem that we feel today. We are heroes and winners.


    Meeting facilitators

    Meeting facilitators

    • Meeting facilitators are ordinary persons in recovery (peer leadership)

      • “Convenors”

        • con = with, together

        • venire = to come

        • “People who bring people together”

    • Six month minimum sobriety requirement


    Practical details

    Practical details

    • A signup sheet is passed

      • To facilitate people’s contacts between meetings

      • Phone and email

    • A basket is passed for voluntary donations


    Other issues

    Other issues

    • Labels are optional

      • Depends on how label affects person’s A-S balance

        • For some, “alcoholic” label heightens vigilance

        • For others, “alcoholic” label paves way to relapse

      • It’s the individual’s choice whether to use label or not


    Other issues1

    Other issues

    • Time keeping is optional

      • But convenors must have six months

      • Officers must have 1 year

      • Directors must have 2 years

      • Relapse = resignation


    Other issues2

    Other issues

    Sponsors

    • Role in 12-step

      • Pilot through 12-step program

      • Consult between meetings

    • PRP is not a formula-type program

      • Usually no role for a pilot (authority figure)

      • Everyone encouraged to consult everyone else between meetings

        • Everyone can be the sponsor of everyone else

        • Each person can have any number of sponsors


    Convenor handbook

    Convenor Handbook

    http://lifering.com


    Hour 5

    Hour 5

    How people build Personal Recovery Programs (PRP)


    Two pathways to prp

    Two Pathways to PRP

    • Through the “How Was Your Week” Meeting Format

    • Through the

      Recovery by Choice

      workbook


    1 prp via hwyw meetings

    (1) PRP via HWYW meetings

    • “Random access”: progress and sequence of program construction depends on what happens in meetings and who happens to be present

    • In each meeting, person may pick up a “nugget” that works for them, and make it part of their recovery plan

    • Like making a mosaic from found stones


    Lifering

    (1)

    “Random

    Access”

    Sequence

    (HWYW

    Meetings)


    Lifering

    (2)

    Structed

    Sequence

    (Workbook)


    1 prp via hwyw meetings1

    (1) PRP via HWYW meetings

    • Advantages: companionship, feedback, all the benefits of positive social interaction

    • Disadvantages: little control over subject matter, may not want to expose private issues, group chemistry may or may not be good fit


    2 prp via rbc workbook

    (2) PRP via RBC Workbook

    • Advantages: control over sequence, timing, subject matter; thorough range of topics; complete privacy; benefits of writing things down; ability to reflect back later; usefulness of a permanent record of one’s own recovery

    • Disadvantages: Cost, lack of social interaction, literacy requirement

    • Possible synthesis: Workbook study groups


    Nine domains work areas

    Nine Domains (Work Areas)

    My Decision

    The Relapse Chapter

    My Recovery Plan


    My decision

    My Decision

    A

    S

    Should I move in with D?

    How it would reinforce my A

    • D’s main squeeze is probably a drunk

    • D’s other roommate keeps wine in fridge

    • There is a liquor store right on the corner

    • I’ll have to work longer hours to afford it

    • I hate the purple paint trim in the hallway, makes me want to drink

    • I’ll have to listen to D’s dog barking at night sometimes, drive me nuts

    How it would reinforce my S

    • D does not drink or use or smoke

    • I will be in a neighborhood with less drugs

    • I’ll have a nicer room, less stress

    • It’s quieter, not so much loud partying

    • I’ll be able to bicycle to work, save commute money

    • I’ll live closer to F and L (sober friends) and spend more time with them

    • I’ll get away from my druggy roommates

    • I’ll get to play with D’s dog

    • There’s a washer-dryer there, don’t have to go to the stinky laundromat

    • Good light, I can have house plants

    • Eventually I can find my own place in that neighborhood


    The a s t chart

    The A-S T-chart

    • Main point:

    • To evaluate every decision in terms of recovery

    • Will my plan strengthen my Sober Self (“S”) and lead me toward a stronger, broader, more satisfying recovery, OR

    • Will my plan strengthen my Addict Self (“A”) and lead me in the direction of relapse?


    The a s t chart1

    The A-S T-chart

    • Question: isn’t this narrow and dogmatic?

    • If I always choose for the S, all my potentials can be realized. The S is the doorway to everything else

    • If I opt for the A, the doors will shut and everything will go down the drain


    Domain 1 my body

    Domain 1: My Body

    2 Telltale Signs

    __ I have some telltale visible signs of my drinking/using on my body, namely:

    __ red eye

    __ burst veins in nose / face

    __ pot belly, overweight

    __ anemic, emaciated

    __ needle track scars

    __ nose damage

    __ stained fingers

    __ skin abscesses

    __ burst veins in legs

    __ shaky hands

    __ scar, fracture or other injury I got while under the influence

    __ bad teeth, gums

    __ other, namely _____________________________

    __ Nobody could tell I drank/used, I look completely normal.


    Domain 1 my body1

    Domain 1: My Body

    12 Exercise

    __ I am physically active and get plenty of exercise each week

    __ I get some exercise each week but a little more wouldn’t hurt

    __ While I drank/used I was an active athlete and in good physical condition

    __ While I drank/used I got very little exercise other than bending the elbow

    __ I am seriously out of shape now

    __ I’ve noticed that I feel better when I take some exercise

    __ I would like to exercise more but can’t figure out how or what or when

    __ I know perfectly well how to exercise more but I just don’t do it

    __ I have noticed that when I exercise it is easier to resist my cravings to drink/use

    __ I am disabled and cannot exercise except in very limited ways

    __ I am going to exercise more, starting __________ (date)

    __ I am not going to change my exercise patterns


    Domain 1 my body2

    Domain 1: My Body


    Domain 1 my body3

    Domain 1: My Body


    Domain 4 my people

    Domain 4: My People


    Domain 4 my people1

    Domain 4: My People


    Domain 4 people

    Domain 4: People


    Domain 4 people1

    Domain 4: People


    Domain 4 people2

    Domain 4: People


    Nine domains work areas1

    Nine Domains (Work Areas)

    My Decision

    The Relapse Chapter

    My Recovery Plan


    Relapse chapter

    Relapse Chapter


    Relapse chapter1

    Relapse Chapter


    Relapse chapter2

    Relapse Chapter


    Relapse chapter3

    Relapse Chapter


    Relapse chapter4

    Relapse Chapter


    Nine domains work areas2

    Nine Domains (Work Areas)

    My Decision

    The Relapse Chapter

    My Recovery Plan


    Pulling the prp together

    Pulling the PRP Together


    Pulling the prp together1

    Pulling the PRP Together


    Pulling the prp together2

    Pulling the PRP Together


    Pulling the prp together3

    Pulling the PRP Together


    Result diversity of programs

    Result: Diversity of Programs

    • Abstinence

    Abstinence


    Pros and cons of prp

    Pros and Cons of PRP

    Cons

    • May be more difficult than working a formula program

    • No answer book

    • Tough questions

    • Forces you to THINK

    • No authority figure

    • Not for everyone

    Pros

    • Investment

    • Motivation

    • Comfort

    • Portability

    • Adaptability

    • Resilience

    • Efficacy


    Why prp more

    Why PRP (more)

    • The most successful client in resisting relapse is one who “confidently acts as his or her own therapist.”– Dimeff & Marlatt, Relapse Prevention, 1995


    Why prp more1

    Why PRP (more)

    “The assembly-line approach ... may work when the content is purely cognitive. But when it comes to emotional competencies, this one-size-fits-all approach represents the old Taylorist efficiency thinking at its worst....We change most effectively when we have a plan for learning that fits our lives, interests, resources, and goals.” -- Daniel Goleman, Working with Emotional Intelligence (2006)


    Why prp more2

    Why PRP (more)

    • “A strong and consistent finding in research on motivation is that people are most likely to undertake and persist in an action when they perceive that they have personally chosen to do so.... When clients are told that they have no choice, they tend to resist change. When their freedom of choice is acknowledged, they are freed to choose change.” --(Miller 1996:93-94).


    Why prp final

    Why PRP (final)

    • Thirty years ago, at the beginning of the HIV crisis, the blood banks desperately needed more donors. They commissioned a study to find out how to reduce donor discomfort and increase donor repeats. They discovered two “magic words” that dramatically reduced donor discomfort and brought them back to donate again and again.

      “Which arm?”

      Chase & Dasy, Harvard Business Review 2001:83


    Conclusions

    Conclusions

    LifeRing is a strength-based approach

    It’s time for choices in recovery


    1 lifering is a strength based approach

    (1)LifeRing is a Strength-Based Approach

    A

    We see both the A and the S, but we concentrate our energies on building up the S

    S


    What we see when we see the strengths

    What we see when we see the strengths

    Seeing only the A

    Seeing the S

    • Powerless

    • Insane

    • Can only surrender

    • Morally defective

    • Focus on errors

    • Menace to others

    • Clueless

    • Diseased

    • Genetically defective

    • Able to abstain from No. 1

    • Capable of reason

    • Able to fight

    • Morally mixed

    • Some wrongs, some rights

    • Some harm, some help

    • Capable of planning

    • Capable of healing

    • Not genetically programmed


    What we see when we see the strengths cont d

    What we see when we see the strengths (cont’d)

    Seeing only the A

    Seeing the S

    • No hope within

    • Nothing inside to build on

    • Nothing within to respect

    • No inherent dignity

    • No goodness inside

    • Can be helped

    • Needs to hide

    • Should be ashamed

    • Deserves pity / contempt

    • Ground for hope within

    • Solid basis to build on

    • Ground for respect

    • Has inherent dignity

    • Has inherent goodness

    • Can help themselves

    • Can well be seen

    • Should be proud

    • Deserves respect & credit


    It makes a difference

    It makes a difference!

    In the Herrick 4N 51-50 ward:

    • “The LifeRing group approach encourages patients to look within themselves and to each other for the strength to achieve abstinence and a healthier lifestyle. … We have found that this approach encourages patients to begin to think positively about themselves and to find a reason to live productively…. The LifeRing meeting is a bright spot in the patients’ week and staff find that participation in the meeting enhances patients’ motivation to get well.”


    2 the aim of lifering is choice

    (2) The Aim of LifeRing is Choice

    • LifeRing does not aim to undermine or to replace any other support group or treatment approach

    • The aim of LifeRing is to provide recovering persons with an additional choice of recovery pathways

    • And to provide the treatment professional with “another arrow in the quiver”


    We need more choices

    We need more choices

    AA Retention Rate; graph adapted from Don McIntyre, “How Well Does A.A. Work? An Analysis of Published A.A. Surveys (1968-1996) and Related Analyses/Comments,” Alcoholism Treatment Quarterly, 18, No. 4, 2000.


    Aa affiliation rate 5 per cent

    AA affiliation rate: 5 per cent

    • More than 80 % walk away within 30 days

    • 90 % walk away within 90 days

    • At the end of a year, only 5 % are left


    Choice should not be controversial

    Choice should not be controversial

    "The roads to recovery are many."-- AA Cofounder Bill W., The AA Grapevine, Sept. 1944, Vol. 1 No. 4.


    It s time for more choices

    It’s time for more choices

    "It is time that the recognition of multiple pathways and styles of recovery fully permeated the philosophies and clinical protocols of all organizations providing addiction treatment and recovery support services." -- William White, MA and Ernest Kurtz, PhD,"The Varieties of Recovery Experience: A Primer for Addiction Treatment Professionals and Recovery Advocates" (2005)


    What can providers do 1

    What can providers do? (1)

    • Get familiar with all the available support options

    • Get, display, and distribute literature from all available support groups

    • Make room space available to meetings

    • Provide a level playing field in support group referrals

      • Provide choices at first contact

      • Eliminate “bounce” referrals

    • Neutralize program forms and literature

    • Neutralize signage and decorations


    What can providers do 2

    What can providers do? (2)

    • Hire and retain staff with multi-path competency

      • TSF and/or MI and/or CBT and/or DBT and/or Choice Theory and/or SFT …

    • Provide clients with multiple treatment pathways

      • Via multi-path protocol in same group, or

      • Via separate groups with adapted protocols

    • Support client initiative in building PRP

      • Mesh with program’s own individualized trx plan


    Choice is good program policy

    Choice is good program policy

    • The 5% retention rate for AA holds lessons for treatment programs

      “The treatment system we currently have ... was devised in 1975, when all we had for treatment was basically group counseling and AA….Most people don't want it; they have to be forced into it.“ -- Mark Willenbring, Director of Div of Treatment and Recovery Research, NIAAA, in Technology Review (MIT) October 27, 2006


    Choice is good program policy1

    Choice is good program policy

    • Single-path approaches limit and erode program census

      • Widespread program camouflage

    • Choice attracts and retains clients


    More choices more recoveries

    More choices = more recoveries


    For more information

    For more information:

    • www.lifering.org – LifeRing, the organization

    • www.lifering.com – LifeRing Press e-commerce store

    • LifeRing Service Center, 1440 Broadway, Ste. 312, Oakland 94612

    • [email protected]

    • 1-800-811-4142


    Available literature 1

    Available literature (1)

    • Empowering Your Sober Self: The LifeRing Approach to Addiction RecoveryPublished 2009 by Jossey-Bass, a division of John Wiley & Sons; with a foreword by William L. White.  

      ISBN 978-0-470-37229-6


    Available literature 2

    Available literature (2)

    Recovery by Choice: Living and Enjoying Life Free of Alcohol and Drugs; a Workbook

    Third printing, LifeRing Press 2006

    ISBN 0-9659429-3-7


    Available literature 3

    Available literature (3)

    How Was Your Week: Bringing People Together in Recovery the LifeRing Way

    Version 1.00, LifeRing Press 2003

    ISBN 0-9659429-4-5


    Available literature 4

    Available literature (4)

    Presenting LifeRing: a Primer for Treatment Professionals

    Third ed., LifeRing Press 2006

    ISBN 0-9659429-5-3


    Available literature 5

    Available literature (5)

    What is Recovery? A Quality of Life Perspective

    By B.J. Davis, Clinical Director, Strategies for Change (Sacramento)

    55-minute DVD

    LifeRing Press 2009


    Available literature 6

    Available literature (6)

    LifeRing 101

    45-minute CD

    Slide show

    Runs on computer only

    LifeRing Press 2001


    Available literature 7

    Available literature (7)

    Brochures

    • Welcome to LifeRing

    • If This is Day One

    • Sobriety is Our Priority

    • Secular is Our Middle Name

    • Self-Help is What We Do

    • LifeRing Online

    • We Come Recommended

    • Give Something Back

    • Choice of Support Groups: It’s the Law

    • Food for the Sober Mind

    • A Different Kind of Workbook


    Available tchotchkes 1

    Available Tchotchkes (1)

    LifeRing Lapel Pin


    The end

    The End


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